醫療照護相關毛黴菌感染症

Healthcare-associated Mucormycosis: A Literature Review

「醫療照護相關毛黴菌感染症」（healthcare-associated mucormycosis）主要發生於器官移植、血液腫瘤、糖尿病、早產兒及具穿透性創傷等病人。其中以Rhizopus為最常見的致病菌數（genus）。病人可因呼吸道吸入、腸胃道食入、或皮膚軟組織接觸環境中的毛黴菌而得病。皮膚軟組織感染症及腸胃道感染症為最常見之醫療照護相關毛黴菌病。曾被報導的群突發感染源包括被毛黴菌污染的繃帶、膠布、床單被服布品、造口引流袋、木質壓舌板、藥丸、灌食液等，及建築物整建時導致毛黴菌散播。和「一般毛黴菌病」比較，醫療照護相關毛黴菌病較常發生於手術病人、較常以皮膚軟組織或腸胃道感染症表現，且大多數病例可以找到可能或明確的感染源。即使病人接受積極的治療，醫療照護相關毛黴菌病死亡率仍高達50%。因此，此病首重疾病的預防。提供給易罹病高危險病人的食物、藥物、床單被服及醫療用品等，均應採取較高的清潔或滅菌標準並儲存於清潔處。近年來，陸續有醫療照護相關毛黴菌病病例被報導，臨床醫師對於高危險病人出現皮膚傷口罕見壞死病灶或壞死性腸炎，應提高警覺，將毛黴菌病列為鑑別診斷。期於毛黴菌病群突發發生時能早期發現，找出環境中的感染源，繼而控制疫情擴散。

Healthcare-associated mucormycosis (HCM) mainly occurs in patients with diabetes, penetrating trauma, and hematological malignancies, as well as immature neonates and patients who have received transplants. Rhizopus species are the most frequently identified pathogen. Reported environmental sources or conditions responsible for HCM outbreaks include contaminated adhesive tape and bandages, hospital linens, ostomy bags, wooden tongue depressors, tablets, feeding solutions, and construction in adjacent buildings. Compared to common mucormycosis (CM), HCM has a higher frequency of skin involvement and is more common among immunocompetent patients undergoing surgery as well as clustered cases with suspected or proven common sources of infection. Despite aggressive treatment, the mortality rate of patients with HCM remains very high: approximately 50%. Therefore, preventive measures are necessary for HCM control. Food, medications, linens, and medical devices provided to patients, especially those at risk for mucormycosis, should be handled and stored with the highest cleanliness and sterilization standards. Clinicians should suspect mucormycosis when unusual necrotizing skin lesions or gastrointestinal infections appear in high-risk populations. Early detection of HCM and identification of contaminated sources are key for effective outbreak control.